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The aim of this study is to explore the safety and efficacy of bee venom immunotherapy without HSA, in real-life patients. Methods: This is an observational retrospective study developed in seven hospitals in Spain, where patients treated with this immunotherapy were included. They gathered the protocol used to initiate the immunotherapy, adverse reactions, field re-stings, and the patient clinical data (clinical history, biomarkers, and skin prick test). Results: A total of 108 patients were included. In total, 4 protocols were used (5 weeks reaching 200 μg, and 4, 3, and 2 weeks reaching 100 μg). An incidence of systemic adverse reactions for each 100 injections of 1.5, 1.7, 0, and 0.58, respectively, was found. The demographic data showed not to directly affect the appearance of adverse reactions, except for those having a grade 2 systemic reaction with immunotherapy previously had a grade 4 systemic reaction; the IgE to Apis mellifera was 3 times higher in patients with systemic reactions of grade 1 than in the general group, and other specific IgEs were lower in those with systemic reactions. Most of the patients recognized Api m 1 followed by Api m 10. In the sample, 32% experienced spontaneous re-stings, without presenting systemic reactions, after a year of treatment. [ABSTRACT FROM AUTHOR]

This study analyze the preferences of preservice teachers about different assessment procedures, and the relationship of these preferences with the students' academic levels, learning styles and motivational orientations. The participants were 248 students in the Teaching degree program (124 first-year students and 124 in their third-year). The results confirmed that the preferences were structured on the basis of two orthogonal dimensions (preferences for conventional and non-conventional methods). There is also a sharp reduction in preferences for conventional procedures depending on the academic level considered, while a slight increase is observed in preferences for non-conventional ones. The preference for non-conventional procedures is associated with a deep learning style, methodical study, and elaborative learning, as well as an intrinsic orientation toward learning, the task value, and academic self-efficacy. Preference for conventional procedures is associated with elaborative processing, an extrinsic orientation toward learning, the task value, and an internal locus of control. (Contains 4 tables.)

Background. Social distancing measures have been one of the core pillars of the strategy against COVID-19 in all the countries. This study aims at understanding what motivates behaviours and compliance with social distancing measures among students and workers from a Spanish public university. Methods. We carry out two logistics models considering two different dependent variables: not maintaining social relation with non-cohabiting people and not to leave home except for emergencies (n = 507, sample is formed by students and workers from the University of Cantabria in the North of Spain). Results. Being very concerned about getting ill suggests higher risk of not maintaining social relation with non-cohabiting people. Getting older increase the probability of not leaving home except for emergencies as happens with those who are very concerned about getting ill. Young people often living with vulnerable older relatives may affect students’ behaviour. Conclusions. Our findings suggest that compliance with social distancing measures depends on several factors related to age, the number or kind of cohabiting people and level of concern about getting ill. Policies should address all these factors through a multidisciplinary perspective. [ABSTRACT FROM AUTHOR]

This paper provides an original Web Assessment Index that focuses on accessibility, speed, navigability, and content. Explains the scoring mechanism, applies the index to assess Web sites of all Spanish universities, and suggests future research. (Author/LRW)

Background: Anemia is the main indication for red blood cell (RBC) transfusion and iron deficiency is the most prevalent, preventable, and treatable cause of anemia worldwide. We aimed to assess the impact of iron deficiency anemia (IDA) on RBC transfusion by means of a program for prevention, early detection, and treatment.Study Design and Methods: A prospective observational study was conducted starting in 2014 after an intervention in clinical practice in Melilla, a peripheral city isolated by 207 km sea distance to nearest continental Spain. Recommendations were proposed for first-step diagnosis of iron deficiency in the laboratory, oral iron prevention and treatment in primary care, and intravenous iron complexes and RBC transfusion for hospital management. Reduction in RBC use for years 2014 to 2016 was the primary outcome, with the period 2010 to 2013 considered as baseline performance for statistical analysis.Results: Compared to baseline, there was a significant (p < 0.05) increase in mean (±SD) yearly reference population (79,748 ± 3265 vs. 85,376 ± 781), ferritin assays (6980 ± 997 vs. 11,794 ± 1567), admissions (6768 ± 239 vs. 7629 ± 191), and subjects exposed to iron therapy (3975 ± 0.0 vs. 4667 ± 21 for oral, 54 ± 7 vs. 257 ± 109 for sucrose, and 128 ± 9 vs.176 ± 15 for carboxymaltose iron). Mean yearly number of RBC units transfused decreased (1622 ± 112 vs. 1434 ± 44; p = 0.043), with a mean reduction of 11.6% from baseline, or 21.4% when estimated by units transfused per 1000 admissions.Conclusions: Management of IDA is a target to avoid RBC transfusion, and awareness of this health problem should be among the first pillars for any patient blood management program. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe and analyze a teleconsultation modality based on a simple telephone call, using either landline or mobile phone, made available to more than two million people. Telecommunication systems are an increasingly common feature in modern healthcare. However, making teleconsultations available to the entire population covered by a public health system is a challenging goal. Design/methodology/approach This retrospective longitudinal observational study analyzed how this modality was used at the primary care level in Galicia, a region in the Northwest of Spain, in 2014 and 2015, focusing on demand, gender and age preferences, rural vs urban population and efficiency. Findings Of 28,472,852 consultations requested in this period, 9.0 percent were telephone consultations. Women requested more telephone consultations (9.9 percent of total consultations) than men (7.7 percent of total consultations). The highest demand occurred for the over 85 age group for both men and women. In both years, 2014 and 2015, the number of telephone consultations per inhabitant was higher in urban (0.53 and 0.69) than in rural areas (0.34 and 0.47). In 10.9 percent of cases, the telephone consultations required further face-to-face consultation. Originality/value Conventional voice telephone calls can efficiently replace conventional face-to-face consultations in primary healthcare in roughly 10 percent of cases. Women are more likely than men to use primary care services in both face-to-face and telephone consultation modalities. Public healthcare systems should consider implementing telephone consultations to deliver their services. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the prevalence of self-reported underuse of medications due to procurement costs amongst older persons from seven European urban communities.Methods: The data were collected in a cross-sectional study ("ABUEL, Elder abuse: A multinational prevalence survey") in 2009. Randomly selected people aged 60-84 years (n = 4,467) from seven urban communities: Stuttgart (Germany), Athens (Greece), Ancona (Italy), Kaunas (Lithuania), Porto (Portugal), Granada (Spain) and Stockholm (Sweden) were interviewed. Response rate - 45.2%. Ethical permission was received in each country.Results: The results indicate that 3.6% (n = 162) of the respondents self-reported refraining from buying prescribed medications due to cost. The highest prevalence of this problem was identified in Lithuania (15.7%, n = 99) and Portugal (4.3%, n = 28). Other countries reported lower percentages of refraining from buying medications (Germany - 2.0%, Italy - 1.6%, Sweden - 1.0%, Greece - 0.6%, Spain - 0.3%). Females refrained more often from buying medications than males (2.6% vs. 4.4%, p < 0.0001). The prevalence of this refraining tended to increase with economic hardship.Discussion: These differences between countries can be only partly described by the financing of health-care systems. In spite of the presence of cost reimbursement mechanisms, patients need to make co-payments (or in some cases to pay the full price) for prescribed medications. This indicates that the purchasing power of people in 10.1186/s12913-015-1089-4 the particular country can play a major role and be related with the economic situation in the country. Lithuania, which has reported the highest refrain rates, had the lowest gross domestic product (at the time of conducting this study) of all participating countries in the study.Conclusions: Refraining from buying the prescribed medications due to cost is a problem for women and men in respect to ageing people in Europe. Prevalence varies by country, sex, and economic hardship. [ABSTRACT FROM AUTHOR]

Background: Smokers undergoing surgery are at a higher risk of complications than non-smokers. Preoperative evaluation by an anesthesiologist could provide an excellent opportunity to promote smoking cessation. Previous surveys of anesthesiologists have found that self-reported smoking cessation counseling rates have room for improvement, but no study has surveyed patients to obtain more accurate estimates. Methods: A single-center study was conducted from January 2010 to June 2010 in a tertiary teaching hospital. A telephone survey was conducted, which included all adult cigarette smokers who visited the preoperative anesthesia clinic. The survey recorded anesthesiologist-delivered interventions to help patients quit smoking before surgery. At the end of the study period, the self-reported smoking cessation counseling of the anesthesiologist was evaluated by questionnaire. Results: One thousand one hundred and sixty-five patients were evaluated, of which 217 were current smokers with a median pack-year of 15 (interquartile range 5.25-30.00) and 34% were scheduled to undergo major surgery. With regard to preoperative interventions, most anesthesiologists (85%) asked about smoking status, although only 31% advised patients about the health risks of smoking and 23% advised patients to quit before surgery. Provision of assistance to help patients quit was provided in 3% of cases. By contrast, 75% of anesthesiologists stated that they frequently or almost always advised patients about the health risks of smoking. Conclusions: This study shows significant discrepancies between direct patient surveys of preoperative smoking cessation counseling activities by anesthesiologists and the self-reported perceptions of the anesthesiologists. Future studies are urgently needed to evaluate the provision of educational materials and other interventions to improve smoking cessation counseling rates among anesthesiologists and to narrow these discrepancies. [ABSTRACT FROM AUTHOR]

We searched the MEDLINE database for publications about telemedicine from 1966 to 2003. Only publications with a first institutional address in Spain and from journals listed in the JCR Science Edition 2002 were included in the study. A total of 118 publications were found. The first publication appeared in 1988 and publication output showed a sudden increase starting in 1995, reaching a maximum in 2002 with 21 publications. The number of authors per publication in non-multicentre studies ranged from 1 to 14 (median 6.5). Most authors (79%) contributed to only a single publication; 10% of authors participated in three or more publications. Most publications were full papers (88%). The most active Autonomous Community in the number of publications relative to inhabitants was Galicia (0.91 publications per 100,000 inhabitants). The Community that produced the highest absolute number of publications was Madrid (29% of the total). The mean impact factor of the journals in which the publications appeared was 0.961. Production of telemedicine publications in Spain has followed the same temporal course as has been observed worldwide. There is an unequal geographical and institutional distribution of publications. The highest production is concentrated in a few institutions and only a small number of authors show steady research activity. [ABSTRACT FROM AUTHOR]

Examines the teleophthalmology link between a primary health care center and an eye clinic at reference hospital in Spain. Identification of telemedicine; Development of computer networks and information technologies for telemedicine; Availability of opthalmic image acquisition devices.

This research note offers an advance of the results of the Spanish political elite survey implemented under the framework of the IntUne Project. After a brief description of the goals and general organization of the project --where we focus particularly on the part of the project dealing with domestic European elites-- the note sets out the details regarding the methodology of the survey it is based on. Then, the main part of the note is devoted to outline the preliminary results of the survey, particularly on the perceptions Spanish diputados (MPs at the lower chamber) have on Europe and the European integration process. [ABSTRACT FROM AUTHOR]

Purpose: Smokers attending smoking cessation units (SCUs) may offer a unique opportunity for early recognition of undiagnosed chronic obstructive pulmonary disease (COPD). We aimed at assessing the impact of SCUs on the early diagnosis of COPD and describing the clinical and smoking profile of newly-diagnosed COPD cases at SCUs certified by the Spanish Society of Respiratory Diseases and Thoracic Surgery (SEPAR)., Patients and Methods: A multicenter cross-sectional observational cohort study (DIPREPOQ study) was performed in eight SEPAR-certified SCUs in Spain. Adult current smokers with no previously diagnosed respiratory disease and having one o more respiratory symptoms were included. Lung functional tests were performed and previously undiagnosed COPD cases were identified and characterized based on national guidelines., Results: Out of 401 individuals newly attending the SCUs, 252 participants were included and 73 (28.9%) met the definition of previously undiagnosed COPD. A characterization of patients with COPD being newly recognized in SCUs showed: age (mean±SD) 61±9 years; men 59%; active work status 53.1%; functional class I/II dyspnea 82.8%, GOLD state mild/moderate/severe 57%/31%/12%; non-exacerbators 90%, CAT 14±4; emphysema in X-rays 40%. Most common co-morbidities were cardiovascular and psychiatric (anxiety and depression) ones. Usual smoking history included a lengthy smoking history (41±9 years) and a current consumption of 24±9 cigarettes/day., Conclusions and Implications: Consistently certified SCUs can have a substantial contribution to early diagnosis of COPD. A typical profile of newly detected cases is reported, with most patients being men at their early sixties, with mild symptoms and with high and lengthy smoking history. Our study reports a high usefulness of lung functional tests to detect undiagnosed COPD in appropriately selected participants attending SCUs at a large national scale, using a standardized methodology. This is likely to be facilitated by the certification of SCUs using well-defined requirements by national scientific societies., Competing Interests: JARM has received honoraria for lecturing, scientific advice, participation in clinical studies or writing for publications for (alphabetical order): AstraZeneca, Boehringer Ingelheim, Chiesi, Laboratorios Esteve, Faes, Gebro, GSK, Menarini, Pfizer, and Rovi, outside the submitted work. CRC has received honoraria for lecturing, scientific advice, participation in clinical studies or writing for publications for pharmaceutical companies, such as Laboratorios Esteve, GSK, Menarini Mundi-Pharma, Novartis, Pfizer, and Teva Pharmaceutical. JIGO has received honoraria for lecturing, scientific advice, participation in clinical studies or writing for publications for (alphabetical order): AstraZeneca, Chiesi, Esteve, Faes, Gebro, Menarini, Pfizer, and Rovi. EPE has received lecture fees and/or support for conference attendance from several pharmaceutical companies, such as Chiesi, Boehringer Ingelheim, Menarini, Pfizer, Novartis, Laboratorios Esteve, Teva Pharmaceutical, Ferrer, or Rovi. FJCG has received lecture fees, consultancy fees and/or support for conference attendance from several pharmaceutical companies, such as GlaxoSmithKline, Chiesi, Boehringer Ingelheim, Mundipharma, Menarini, Pfizer, Novartis, Laboratorios Esteve, Teva Pharmaceutical, Ferrer, Rovi, Roche, Astra Zeneca, Bial, Actelion, Grifols, CSL Behring, Faes Farma, and Gebro Pharma. CAJ-R has received honoraria for lecturing, scientific advice, participation in clinical studies or writing for publications for (alphabetical order): Gebro, Menarini and Pfizer. AAA is full-time employee at Laboratorios Esteve, Spain. The remaining authors report no conflicts of interest to be disclosed in this work., (© 2021 Riesco-Miranda et al.)

Background: The concept of clinical control has been proposed as an instrument for evaluating patients with COPD. However, the possible association between clinical control, reduced symptom severity and HRQoL has yet to be confirmed., Methods: This multicentre, prospective and observational study was carried out in 15 pulmonology clinics in Spain. The patients were followed up for six months, with a baseline visit (V0), followed by visits at three months (V1) and six months (V2). Clinical control was determined at V1, with the application of both clinical criteria and the COPD assessment test (CAT). All patients reported their symptoms by a validated symptom diary (E-RS) using a portable device, and their HRQoL was assessed using the EQ5D questionnaire. The relationship between clinical control and E-RS and HRQoL during follow-up was assessed with t -test., Results: A total of 126 patients were screened. After application of the inclusion/exclusion criteria, 93 were finally included (mean age 66 ± 8 years, 84.9% male), with a mean FEV 1 predicted of 49.8% ± 16.5%. Of these patients, 44 (47.3%) achieved clinical control at V1, according to CAT criteria, and 50 (53.8%), according to clinical criteria. The E-RS scores differed between controlled and uncontrolled patients at all time points, both according to CAT (mean differences of -4.6, -5.6 and -6.2 units at V0, V1 and V2, respectively, p<0.005 for all comparisons) and to clinical criteria (mean differences of -3.3, -5-6 and -4.99 units, respectively, p<0.005 for all comparisons). The controlled patients also presented a significantly better HRQoL, measured by the EQ5D questionnaire (mean difference 0.13 and 0.10 at V2 by CAT or clinical criteria, respectively, p<0.05)., Conclusion: Clinical control in patients with COPD, whether measured by CAT or by clinical criteria, is associated with a lower symptom load and a better HRQoL., Competing Interests: Dr. Alcázar-Navarrete reports grants, non-financial support and personal fees from GSK, grants, personal fees and non-financial support from Novartis AG, personal fees and non-financial support from Boehringer Ingelheim, personal fees and non-financial support from Chiesi, grants, personal fees and non-financial support from Laboratorios Menarini, personal fees from Gebro, personal fees and non-financial support from Astra-Zeneca, personal fees from Laboratorios Rovi, personal fees from Laboratorios Ferrer, grants, personal fees, non-financial support from Menarini, outside the submitted work. Dra. Fuster has nothing to disclose. Dra García-Sidro reports personal fees from GSK, Pfizer, Novartis AG, Menarini, Boehringer Ingelheim, Astra-Zeneca, Gebro and Laboratorios Rovi, outside the submitted work. Dr. García Rivero has nothing to disclose. Dr. Abascal-Bolado has nothing to disclose. Dr. Pallarés-Sanmartín has received lecture fees, consultancy fees and/or support for conference attendance from various pharmaceutical companies such as Novartis, GlaxoSmithKline, Chiesi, Boehringer Ingelheim, Mundipharma, Menarini, Laboratorios Esteve, Astra Zeneca, Teva Pharmaceutical, Ferrer, Rovi, Bial, Faes Farma, ALK Abelló and Gebro Pharma outside the submitted work. Dr. Marquez- Martín has nothing to disclose. Dr. Valido Morales has received lecture fees, consultancy fees and/or support for conference attendance from various pharmaceutical companies, such as GlaxoSmithKline, Chiesi, Boehringer Ingelheim, Menarini, Pfizer, Novartis, Laboratorios Esteve, Teva Pharmaceutical, Ferrer, Rovi, Astra Zeneca, Bial, Grifols, Faes Farma and Gebro Pharma, outside the submitted work. Dr. Callejas González has received lecture fees, consultancy fees and/or support for conference attendance from various pharmaceutical companies, such as GlaxoSmithKline, Chiesi, Boehringer Ingelheim, Mundipharma, Menarini, Pfizer, Novartis, Laboratorios Esteve, Teva Pharmaceutical, Ferrer, Rovi, Roche, Astra Zeneca, Bial, Actelion, Grifols, CSL Behring, Faes Farma and Gebro Pharma, and reports personal fees from GlaxoSmithKline, personal fees from Chiesi, personal fees from Boehringer Ingelheim, personal fees from Mundipharma, personal fees from Menarini, personal fees from Pfizer, personal fees from Novartis, personal fees from Laboratorios Esteve, personal fees from Teva Pharmaceutical, personal fees from Ferrer, personal fees from Rovi, personal fees from Roche, personal fees from Astra Zeneca, personal fees from Bial, personal fees from Actelion, personal fees from Grifols, personal fees from CSL Behring, personal fees from Faes Farma, personal fees from Gebro Pharma, outside the submitted work. Dra. Palop reports personal fees from Astra Zeneca, GlaxoSmithKline, Chiesi, Boehringer -Ingelheim, Novartis, Teva, Menarini, Rovi, outside the submitted work. Dr. JA Riesco reports grants and personal fees from GSK, grants, personal fees and non-financial support from Pfizer, Novartis AG, Menarini, personal fees and non-financial support from Boehringer Ingelheim, personal fees and non-financial from Astra-Zeneca, Grants and personal fees from Gebro, personal fees from Laboratorios Rovi, outside the submitted work. Dr. Golpe reports personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Menarini, Rovi, Zambon, Grifols, Novartis, Ferrer, Gebro Pharma, Laboratorios Esteve and GlaxoSmithKline, outside the submitted work. Dr. Soler-Cataluña reports speaking fees from Laboratorio Esteve, Mundipharma, grants, personal fees, speaking fees from AstraZeneca, grants, personal fees, non-financial support from Boehringer Ingelheim, personal fees from Bial, personal fees from Ferrer, personal fees, non-financial support from Menarini, personal fees, non-financial support from Novartis, personal fees from Rovi and Teva; consulting fees from AirLiquide, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Laboratorios Esteve, Mundipharma grants, personal fees from Chiesi, personal fees from Ferrer, grants, personal fees from; research grants from GlaxoSmithKline and Boehringer Ingelheim, outside the submitted work. Marc Miravitlles has received speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, Menarini, Rovi, Bial, Sandoz, Zambon, CSL Behring, Grifols and Novartis, consulting fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Bial, Gebro Pharma, Kamada, CSL Behring, Laboratorios Esteve, Ferrer, Mereo Biopharma, Verona Pharma, TEVA, Spin Therapeutics, pH Pharma, Novartis, Sanofi and Grifols and research grants from GlaxoSmithKline and Grifols; reports personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, Menarini, Rovi, Bial, Sandoz, Zambon, CSL Behring, Grifols and Novartis, personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Bial, Gebro Pharma, Kamada, CSL Behring, Laboratorios Esteve, Ferrer, Mereo Biopharma, Verona Pharma, TEVA, Spin Therapeutics, pH Pharma, Novartis, Sanofi and Grifols, grants from GlaxoSmithKline and Grifols., outside the submitted work. The authors report no other potential conflicts of interest for this work., (© 2020 Alcazar-Navarrete et al.)

Objective: To identify the variables that influence blood loss in endoscopic sinus surgery performed under uniform conditions of preoperative topical vasoconstriction and surgical technique., Study Design: Blind, nonrandomized, observational study., Setting: One hundred thirty-eight consecutive patients who underwent endoscopic sinus surgery with the same technique in a university hospital over a 9-month period., Methods: Pearson product-moment correlation was used for numerical variables and nonparametric tests for categorical variables: Mann-Whitney (comparison of two independent variables) and Kruskal-Wallis (comparison of more than two independent variables)., Main Outcome Measures: Operative time, total blood loss, and blood loss per minute were correlated with blood loss markers: age, sex, surgeon, type and severity of illness, septoplasty, and anesthetic agents used., Results: No correlation was found between age, sex, surgeon, and blood loss markers. Severe polyposis produced more blood loss than mild polyposis and sinusitis. Septoplasty showed an interesting inverse correlation with blood loss. Remifentanyl with fluorinated volatile agents was accompanied by less blood loss than other anesthetic agents., Conclusion: More blood loss occurred with more severe sinonasal pathology. Blood loss may be reduced by using remifentanyl with a fluorinated volatile agent and, possibly, preoperative infiltration with epinephrine.

Diabetes and systemic hypertension are among the most prevalent diseases in developed countries. Since both can produce retinal involvement, they often cause long waiting lists for ophthalmologist consultation. The inspection of digital eye fundus images by a general practitioner would help to divert only those cases with retinal involvement. To evaluate this possibility we studied the agreement between the assessment of digital fundus images made by a general practitioner and an ophthalmologist. A total of 776 fundus images of 194 patients were inspected by both observers looking for retinal lesions consistent with diabetic or hypertensive retinopathy. Contingency tables were made, and the agreement between both observers was assessed by using the kappa index. We found good agreement between the findings reported by the general practitioner and those reported by the ophthalmologist (kappa = 0.80 for patients with only diabetes, 1.00 for patients with only hypertension, and 0.79 for patients with both diseases). Our results suggest that the inspection of digital retinal images by a general practitioner could reduce the number of referred patients for specialist consultation.